By Financial Disclosures, We're Fixing the Wrong Problem

Jerome P. Kassirer, MD


September 24, 2007


This feature requires the newest version of Flash. You can download it here.

For several years medical editors have been castigated for failing to disclose the financial ties between some of their prominent authors and the drug industry. None of the major journals have escaped the public's wrath, and all of them have tightened their disclosure policies by requiring more and more personal financial detail.

Disclosure is widely considered the "great disinfectant," the best way to manage financial conflicts of interest, and thus clean the informational palate of all bias. Unfortunately, disclosure does no such thing. Disclosure may alert readers of possible bias, but it requires them to become mind readers. Did the author pen an unvarnished manuscript? Were his opinions subtly influenced by consulting or speakers' fees? Did he intentionally bias the material to satisfy the company whose fees help to pay for his daughter's college tuition? Interpreting the opinions and recommendations of financially conflicted authors in editorials and review articles is more akin to reading a mystery novel than reading a scientific paper.[1] I believe that an excessive focus on disclosure has distracted us from paying attention to the real problem, namely, the conflict itself.

Financially conflicted experts are often given waivers and allowed to serve on clinical practice guideline committees, FDA panels, and United States public health panels, and many are selected to write for the best journals regardless of the extent and depth of their financial ties.[2]

Disclosure is certainly a necessary, but not a sufficient, solution to these conflicts. Rather than obsess on disclosure or lack thereof, let's begin to deal with the real problem, namely, the conflicts themselves.[3] When we want clinical advice that can affect thousands of patients, let's try harder to find unconflicted experts so we don't have to try to figure out what the writers really think.[4]

That's my opinion. I'm Dr. Jerome Kassirer, Distinguished Professor of Medicine at Tufts University School of Medicine and Visiting Professor at Stanford University.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: